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By Dhanashree Padhye

MA (Psychology)

28 September 2022
Medically reviewed by
Dhanashree Padhye
MA (Psychology)
Anxiety and Fear
Table of Contents

Anxiety is the response of a human being to any threat or danger. Every experience of Anxiety involves a perception of risk, thoughts about harm, and a process of physiological alarm and activation. Anxiety is a feeling of fear, dread and uneasiness. (Chand SP, Marwaha R)
 
Sigmund Freud defined Anxiety as "The symptomatic expression of the inner emotional conflict caused when a person suppresses (from conscious awareness) experiences, feelings, or impulses that are too threatening or disturbing to live with." 
 
The acute stress response is essential in understanding the usual reaction to stressors and has guided research, but it has some limitations for understanding Anxiety (Barbee, 1998). 
 
Depression and Anxiety are both common mental disorders, with prevalence
Of 10–44% in developing countries, depression is the fourth leading cause of
morbidity (Wang, C., & Zhao, H. 2020)
 

Signs of Anxiety

The signs of Anxiety include Feeling restless, wound-up or on edge, easily fatigued, and having difficulty concentrating. Being irritable, having headaches, muscle aches, stomach aches and specific unexplained pains, difficulty controlling feelings of worry, and having sleep problems are common anxiety symptoms.
 
Social phobia describes  Fear and Anxiety as leading to avoidance of social interaction in social situations (Bonjardim, L.R., Gavião, M.B.D., Pereira, L.J. and Castelo, P.M., 2005).
 

Symptoms

Common anxiety signs and symptoms include:

· Feeling nervous, restless or tense
· Having a sense of impending danger, panic or doom
· Having an increased heart rate
· Breathing rapidly (hyperventilation)
· Trouble concentrating  
· Sweating
· Trembling
· Feeling weak or tired 

Causes and risk factors 

These factors will increase the risk of developing an anxiety disorder:

· Trauma

Children who endured Abuse or Trauma in childhood or witnessed traumatic events are at higher risk of developing an anxiety disorder. Adults who experience a traumatic event can develop anxiety disorders as well. 

· Stress of an illness

Having a health condition or serious problems can cause stress about future treatment.

· Stress build-up

A build-up of smaller stressful life events may trigger excessive worry and may lead to Anxiety.

· Personality

People with certain personality types are more prone to anxiety disorders than others.

· Other mental health disorders

People with depression often have an anxiety disorder.

· Having blood relatives with an anxiety disorder

Anxiety disorders can be genetic in some cases.

· Drugs or alcohol

Overuse or misuse and withdrawal can cause or worsen Anxiety.

Diagnosis and Treatment of Anxiety 

Treatment

The treatments for Anxiety disorders involve psychotherapy and medications. In some cases, doctors will advise taking medications along with the therapy to reduce symptoms of Anxiety. 

Psychotherapy

Talk therapy or psychological counselling involves working with a therapist to reduce anxiety symptoms.  

Cognitive behavioural therapy (CBT)

It is the most effective form of psychotherapy to treat anxiety disorder.  CBT will help you focus on specific skills to improve your symptoms and gradually return to the activities you were avoiding due to Anxiety.

Exposure Therapy

  • It is a kind of behavioural therapy. A person is exposed to a situation, event, or object that triggers Anxiety, fear, or panic, for example, getting anxious after seeing a snake.
  • The therapist will use imaginal exposure to help the client imagine the whole situation in his head and then prepare him for a response to the trigger.
  • After some time, the client will learn controlled exposure to a trigger which will help reduce anxiety or panic in such a case.

Different exposure therapies

Therapies like vivo exposure, Imaginal exposure, Virtual reality exposure, and Interoceptive exposure may be used. These techniques will help build confidence while managing a situation and Anxiety symptoms.

Medications

Medications are prescribed based on an Anxiety type and other mental or physical health issues. 

For example:

· Antidepressants 
· An anti-anxiety medication 
· Doctor may prescribe medications, like benzodiazepines, sedatives or beta blockers. 

What is Fear?

Dan Brown says, "Men go to far greater lengths to avoid what they fear than to obtain what they desire". When we identify a threat, the body will respond in a particular way—given a choice; any average person will choose to avoid a fearful or dreadful situation while walking on the path of success.

Fear is an automatic neurophysiological state of alarm characterized by a fight or flight response to a cognitive appraisal of present or imminent danger (real or perceived). Fear signals us to the presence of danger and the threat of harm. Fear is a natural response, but it can lead to distress and disruption in extreme cases.


Signs and symptoms

Some of the common symptoms of fear involve:

  • Dry mouth
  • Nausea
  • Rapid heartbeat
  • Sweating 
  • Trembling
  • Shortness of breath (Bausewein C, Simon ST)
  • Chest pain
  • Chills
  • Upset stomach

Psychological symptoms of fear:

  • Feeling detached from the body
  • Inability to focus and concentrate
  • Feeling a sense of stress
  • Lacking emotional control
  • A pending sense of doom

Fear involves two primary reactions to a perceived threat:

Biochemical Reaction
Fear is a survival mechanism which responds in specific ways while confronting a perceived threat. Our body produces physical reactions to fear, including Sweating, increased heart rate, and high adrenaline levels. The physical response is also called the "fight or flight" response. Our body will prepare to enter combat or run away from the situation.

Emotional Response
The emotional response to fear will differ for every individual. People can experience positive or negative emotions to fear, as the biology of fear involves the same chemical responses to positive emotions and negative emotions.

Although the biochemical reaction to fear is the same, some people will experience the intensity of fearful situations differently than others.

When feelings of fear become persistent and excessive, they are diagnosed as an Anxiety disorder depending on the symptoms associated with fear: phobias, generalized Anxiety disorder, social anxiety disorder, and panic disorder.

Causes and Risk factors 

There is no single primary cause for fear. Some fears result from Trauma, while others may represent a fear of something else, such as losing control. Some of the fears occur since they cause physical symptoms, such as fear of heights.

Some common fear triggers include:

  • Particular objects or situations (spiders, snakes, heights, flying, Etc.)
  • Future events
  • Imagined events
  • Real environmental dangers
  • The unknown
  • Specific fears tend to be innate and may be evolutionarily influenced because they aid in survival. Others are learned and are connected to associations or traumatic experiences. 

Types of Fear

Some of the different types of anxiety disorders that are characterized by fear include:

  • Agoraphobia
  • Generalized anxiety disorder
  • Panic disorder
  • Post-traumatic stress disorder (PTSD)
  • Separation anxiety disorder
  • Social anxiety disorder
  • Specific phobia

Diagnosis and Treatment of Fear 

Treatments for phobias can be used for conditions associated with extreme fear since they involve repeated disclosure of the feared situation until the patient becomes familiar with the fear response.

Systematic Desensitization is one type of therapy used for people with extreme fears. In systematic desensitization, the therapist helps the client to go through a series of situations, gradually leading them towards fearful stimuli. It is used for those with specific fears and phobias.

For instance, if someone has a phobia of lizards, the steps may go as follows:

1. Talking to the therapist about lizards
2. See pictures of lizards – this could start as drawings and gradually get more realistic until the patient can manage to view a photo of one.
3. The patient may be encouraged to watch video footage of a lizard.
4. The patient could handle a toy lizard
5. Eventually, the patient should get to a stage where they can face a genuine lizard

Difference between Anxiety and Fear

The differences in symptom expression between fear and Anxiety are centred on several factors, including:

  • Your emotional & mental capacity
  • Your available resources to help you cope
  • What event triggered your response 

Fear is a central emotional state elicited by conditioned stimuli associated with punishment, and Anxiety is a state elicited by such stimuli; indeed, it is the same stage. Fear is a subspecies of anxiety. Fear is a state that occurs during a panic attack and is quite a distinct state from anxiety supported by pharmacological evidence.

The difference between Fear vs Anxiety is based on a difference between excessive and dysfunctional emotions. Anxiety is an excessive and unfocused fear that various stimuli may trigger, but fear is an emotional reaction to a specific, real danger. Anxiety caused by stress may continue for a long time after the trigger is removed or arise with no trigger at all.

How to Tell If You are Feeling Fear or Anxiety

Anxiety sensitivity refers to the tendency to respond fearfully to the bodily sensations associated with fear and anxiety. Fear responds to a current threat, whereas anxiety is oriented towards the future. In other words, fear is a reaction to somewhat clear and present danger, whereas Anxiety is a reaction to an anticipated situation in the future.

For a situation to be interpreted as anxiety-provoking cognitive theory assumes that the perceptual information it conveys is processed with the belief systems of the individual information called up from long-term memory to define dire circumstances. The belief systems of anxiety-prone individuals are specified regarding danger, risks Etc.


Fear is a strong, stimulus-driven aversive response evoked by incompletely processed stimuli obtained by evolutionary sources. Individuals may differ in their vulnerability to anxiety disorders because their fear modules can be differently sensitive to stress. 
In State anxiety the experiences of unpleasant feelings are described in detail.

Generally, State anxiety arises when the person makes a mental judgement of any threat with certain stimuli or situations. When the threatening situation goes away, the person will no longer experience anxiety symptoms.

When to Seek Assistance

If anyone goes through frightening experiences or faces anxiety-related issues, do encourage them to make an appointment with a mental health provider. Reminding them of initial check-in is necessary to better care for their emotional health. 

See your doctor if:

· You are worrying more than usual if it interferes with your daily routine, relationships or other aspects of life.
· If you cannot control fear, worry or anxiety and if it upsets you.
· When you feel depressed, have trouble with alcohol or drug use, or have any mental health concerns and anxiety.
· If you think your anxiety could be linked to a physical health problem.
· You have suicidal thoughts or behaviours — if this is the case, seek emergency treatment immediately.

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